All women know they're supposed to get an annual screening for breast cancer -- but a recent Yale study says that there's no real evidence that costly screenings are benefiting women over 75.

Cary Gross, an associate professor of medicine at Yale, cautions that the study results don't mean that mammograms aren't effective and that women shouldn't get them.

"It simply says that in women over 75, there is no evidence whether or not the screenings are effective in bringing about better outcomes," he said. "We need further study."

This is significant because Medicare pays more than $1 billion per year for breast cancer screenings. More than $400 million of that is spent on women over the age of 75, Gross said.

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Gross, who is the director of the Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, said his study looked at overall costs of screening and treatment, and then at overall national costs and the variation in cost in different regions of the country.

Researchers studied more than 137,000 female Medicare beneficiaries who had not had breast cancer and followed them for two years to observe which screenings they had, and any later incidence of breast cancer, as well as the cost of their treatments.

What they found was that the costs of breast cancer screenings varied widely throughout the country. In some areas, Medicare spent only $40, while in other areas, the cost was closer to $110 per patient.

"It was the type of technology that made the difference," said Gross. "In areas where women were tested using digital and computer-aided detection, the cost was more. But what we found was that there was no relation between the higher expense of screening and the improved outcomes for the patients."

Gross emphasized that the study followed patients for only two years, and that perhaps the results would shift over time. "But if you think about screening," he said, "you would argue that if spending more on screening is effective, you should have a lower incidence of metastatic disease in those areas. But in fact, there's no relation."

He said that these findings underscore the need for further studies. "In some instances, breast cancer screening can save lives. But no woman wants to undergo testing if it's likely to cause more harm than good, and no health system -- particularly ours -- can afford to spend hundreds of millions of dollars on screening programs without evidence to support them."

One of the challenges in treating an aging population is how to make those decisions, he said, and physicians have not been given the information to help them talk to their patients.

With his own patients, he said that some patients in their 80s still wish to get mammograms every year, while others say they don't want to look for additional health problems they might find.

"For me, the issue is that people should be treated in a way that aligns with their preference," he said. "Within the Medicare program, what's the best way to help each and every patient? The issue is spending the money wisely."

Doctors, he said, shouldn't ration needed care. "When working with individual patients, the decision needs to be based on the interest of the patient," he said. "If there is a test or procedure that would be helpful, certainly the question of saving the health system money shouldn't play a role."

But if there are tests or interventions that aren't going to help patients -- perhaps patients with complicating factors or who have a limited life expectancy -- then Gross said those should not be offered.

"We're spending a lot of money, and we're not sure what we're getting out of it," he said. "More is definitely not always better."